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Dr. Cynthia Ross is a rare commodity in Arkansas.

The radiation oncologist, who works at Central Arkansas Radiation Therapy Institute/Baptist, is among just a handful of specialists in that genre in the entire state.

"In Little Rock, you have nine that work in the CARTI system and three more who work at UAMS," Ross said. "For the rest of the state, it isn't that many more, I'd say around 20 or so."

But Ross wasn't always going to be a radiation oncologist. At first, she wasn't even sure about being a doctor.

"I was working in a dentist's office; my father was a dentist," Ross explained. "I considered being a med tech, and there was a med tech at the office where I worked, and he told me to go into medicine. He said if you are going to do it, go all the way."

So with that, the Blytheville native headed to Fayetteville for undergrad and back to Little Rock and UAMS for medical school.

"I started out and went to medical school with the intention of going back to Mexico and going into primary care," said Ross, who had done a semester of high school in Mexico. "I wasn't comfortable doing family medicine. It was just too vast a field for me, so I started looking at doing something more specific.

"One day, I was eating lunch with a radiology student, and I was telling him I was looking at doing something different, and he told me about radiology. I liked the idea of radiation therapy. I liked the idea of being able to treat something and make a significant difference.

"… I started out wanting to do it all, and then I figured out that I couldn't do it all. That might have been that 'a-ha' moment when I figured out that I couldn't do it all or wasn't comfortable to do it all, so then I started looking around."

At the time, UAMS didn't have a residency program for radiation therapy, and Ross headed north to Iowa City for her training.

Ross's training was unique; not many physicians practiced the specialty.

"It is a very tiny field of medicine," Ross said. "So a lot of people don't know much about it, even practicing physicians. It is so different, so high tech. It is a very small field inside the oncology field. It isn't diagnostic radiology; it is radiation therapy."

Ross, unlike many other physicians, works Monday through Friday with regular office hours. Not many late nights, not many weekends spent on call.

"What we do is treat cancer with radiation," she said. "A typical day seeing new patients, we do what we call the initial consultation, those patients with a new diagnosis of cancer and most likely will need radiation therapy, and I do not do the diagnostic work."

The typical workup includes visiting and examining the patient, and also reading their records and looking at the various films.

"I make the decision if they need radiation," Ross said. "The referring physician, most of the time, knows when their patients need radiation. Then the following day, we begin the treatment planning process, which involves something called simulation, which is usually done with CT-based treatment planning. Then we do virtual simulation, which is treatment planning on the computer, and that can take a big part of my day."

Ross said she sees two to five new patients a day, two or three patients in a follow-up, and then the rest of her time is spent planning treatment, which she calls a "physics project," and also doing paperwork.

CARTI/Baptist treated 487 patients last year; 462 were new patients. In the CARTI system, nearly 3,000 patients a year receive treatment.

"Two minutes" is how long Ross said it takes for a treatment. "Most patients are given time slots between 10 and 20 minutes. We get them out pretty quickly. CARTI is pretty efficient."

But for good reason — some patients drive hours for treatments that could be administered every day for weeks on end, so getting them in and out is a good thing.

As for the types of cancers treated, Ross said, "We treat the most common kinds, lots of breast cancer. Probably about half of them are breast cancers, but you have the big three: breast, lung and prostate. Those make up the vast majority of what we do."

Ross has been witness to the changes in radiation therapy from a front row seat.

"The computer software has really revolutionized everything, from planning to treatment," she said. "That has been the biggest change, this software that allows this very precise treatment planning process, all on the computer. You have three-dimensional, four-dimensional, all sorts of modulations. Seeing everything, fusing all the imagery with the planning program and what we want to treat, what we don't want to treat … then having the computer software that can put that into the machine and actually deliver that, reliably."

The key has been the precision."The beauty of that, the take-home message, is this: radiation can kill more or less any tumor, but the host, the person's body, has tissue tolerance … whatever we can do to modify the dose to the normal tissue, the better the chance that we can get them a good enough dose to potentially kill the cancer.

"… It has clearly been shown that higher doses cure more cancer, and because we can treat less normal tissue, we are able to deliver higher doses. Basically we can cure more and hurt less," she said.

The problem is that the research hasn't caught up with the technology.

"We still don't have solid data on everything," Ross said. "Intuitively, the higher dose that you can give safely, the better it is for the patient."

And in the end, saving lives is all that matters.




December 2006

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